SIREN: FLORIDA, WISCONSIN THREATEN TO HALT IMPLEMENTATION – Florida Gov. Rick Scott has aggressively seized on Vinson’s ruling, telling reporters he will not move forward with implementation. Scott in the Palm Beach Post: “We are not going to spend a lot of time and money with regard to trying to get ready to implement that until we know exactly what is going to happen.” Palm Beach Post story http://bit.ly/eTyMdG

MEANWHILE, IN WISCONSIN – Attorney General J.B. Van Hollen in a Tuesday p.m. statement: “Judge Vinson declared the health care law void and stated in his decision that a declaratory judgment is the functional equivalent of an injunction. This means that, for Wisconsin, the federal health care law is dead—unless and until it is revived by an appellate court. Effectively, Wisconsin was relieved of any obligations or duties that were created under terms of the federal health care law.”

--BUT HOW SERIOUS ARE THEY? Wis. Gov. Scott Walker’s office declined to comment to PULSE on Van Hollen’s statement. Previously though, Walker has indicated a willingness to work with HHS on reform. As he told us in an interview right before taking office: “If we can find a way to define our own reform, obviously within the realm of health care, and as long as [the federal government] doesn’t restrict how we can do that, then I think we’d be inclined.” Walker also did not stop his state from applying for an Early Innovator Grant, nor did he mention blocking health reform in his State of the State address last night.

--LOOMING: COULD VINSON’S ORDER FORCE SCOTUS TO ACT MORE QUICKLY? If the DOJ decides it needs a stay order to legally implement the health reform law, the order could quickly work its way up to the Supreme Court, Santa Clara University law professor Bradley Joondeph writes. If the stay is needed, it could quickly be appealed to the 11th Circuit and possibly SCOTUS. Joondeph writes the ACA litigation blog. The post http://bit.ly/fsaQd3

Good Wednesday Morning. “Dang me, dang me, ought to take a rope and hang me high form the highest tree—Pulse, would you weep for me?” (Hat tip: Politico health’s J. Lester Feder, who you can now follow at @jlesterfeder. Special PULSE prize to the first person who can tell us what the “J” stands for.)

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DRIVING THE DAY: SENATE REPEAL VOTE EXPECTED – The Senate is likely to vote on an amendment to repeal the health reform law today, but of course, it won’t pass. In fact, no Democrats are likely to support it. Sen. Mitch McConnell introduced the amendment Tuesday and said he expects all 47 Republicans to support it. Majority Leader Harry Reid said he’ll quickly move to get rid of the amendment, likely by calling a budget point of order – a procedural vote designed to highlight the fact that CBO says repeal would cost $230 billion. (So, technically, lawmakers will be voting on a procedural motion and not on health repeal itself. But in reality, it's a vote on repeal.) The POLITICO story http://politi.co/gXaMHw

--GRAHAM, BARRASSO INTRODUCE STATE OPT-OUT— Sen. Lindsey Graham and John Barrasso introduced their bill to allow states to opt-out of the individual mandate, employer mandate and Medicaid expansion on Tuesday. Graham said his goal in introducing the legislation is to take down the entire health reform law. “If you take half the states out of the individual mandate, this [health reform] bill falls,” he said. “Quite frankly, that’s the goal.” The POLITICO story http://politi.co/hlvBwg

PULSE EXCLUSIVE: ANTI-ABORTION COALITION LAUNCHES “EXPOSE PLANNED PARENTHOOD” SITE – Led by SBA List, a new site goes live this morning with an “online activism center,” where activists can lobby members to support Pence’s bill to strip Planned Parenthood of its Title X funding. A companion outreach campaign will ask activists to lobby members through e-mails, letters to the editor and letters to local Congressional offices. The POLITICO story http://politi.co/fY4zqz The site http://bit.ly/hvWChK

** A message from BD (Becton, Dickinson and Company): BD applies its technologies and expertise to help governments and healthcare institutions prevent, detect, diagnose, manage and report infections. www.bd.com/preventinfection **

SHOULDN'T REPUBLICANS LOVE THE MANDATE? In a different context, the Republican Party might cheer one of the fundamental tenets of the health care law, a requirement that all Americans buy health insurance. It’s just the sort of thing that would fit squarely within the GOP’s bedrock principle of individual responsibility. Instead, Republicans have made the individual mandate the focus of their attacks on President Barack Obama’s health care law. The story from POLITICO's David Nather: http://politi.co/fjhh42

DEPARLE SKIPS ACO EVENT… – Apologizing for Nancy-Ann DeParle’s last-minute bailing on yesterday’s ACO event at Brookings, Mark McClellan said she would “not be able to join us because of the urgent situation in the Middle East and other matters related to her new position as deputy chief of staff.” The White House did not respond to PULSE’s request for information about what other non-health care matters are now in her portfolio.

…BUT BERWICK SPEAKS – Before a packed House of policy wonks, providers and reporters at Brookings, the oft-cloistered CMS chief talked about accountable care organizations. Yes, his then teenaged patient Kevin made an appearance, rhetorically speaking. Afterward, Berwick took a few questions, but didn’t give much away in terms of the ACO rule. Read his speech here: http://politi.co/e0TYm9

ICYMI: STEVE LARSEN TAKES OVER CCIIO – Sebelius tapped Larsen, up until now CCIIO’s director of the Division of Insurance, to head up the entire agency. A former insurance commissioner in Maryland, Larsen was heavily involved in work in the medical loss ratio regulation. The change, an HHS source tells us, is effective immediately. The POLITICO story http://politi.co/hLvM0p

SCOOPLET: ILLINOIS REFORM REPORT DELAYED – Although the Illinois Health Reform Implementation Council promised to deliver by the end of January, the recommendations still have not been finalized, a well-placed source tells us. They’re aiming to get the report out today.

BIZ LOBBIES FOR FSA ACCOUNTS – Kaiser Health News’ Jordan Rau on POLITICO today: Some of the largest of the 500 companies that administer FSAs, as well as drug makers and business groups, are organizing and funding the drive to change the law, which they say may reduce the number of people using these accounts. The KHN/POLITICO story http://politi.co/hYqfgW

OUT TODAY: COMMONWEALTH RANKS STATES BY CHILDREN’S HEALTH – Iowa tops the group’s regular look at how the health care system serves the under 18 population. Study http://bit.ly/f1Ik4X

--ALSO THIS MORNING: HHS, MICROSOFT ANNOUNCE NEW PARTNERSHIP – HHS and Microsoft will announce today a new encrypted messaging application, that uses Microsoft Health Vault and allows clinicians to send e-mail messages and clinical information to patients in a safe, secure format. Full announcement from HHS at noon today.

AMA RELEASES DATA ON (NON)-COMPETITIVENESS IN INSURANCE INDUSTRY – Study released yesterday found that in 60 percent of metropolitan areas, the two largest insurers dominated 70 percent of the market. And in 18 percent of cities, at least one insurer controlled 70 percent or more of the market.

--AHIP SAYS: NOT QUITE – “Competition is vigorous among health plans across the country,” AHIP’s Robert Zirkelbach pushes back. “They operate in highly competitive markets in which consumers have numerous choices among plan types and insurers. Moreover, research examining competition in health care markets increasingly points to provider consolidation as a significant factor contributing to rising health care costs.” He also points out that a HealthCare.Gov search will bring up multiple options for the vast majority of consumers.

HAPPENING TODAY: JUDICIARY HEARING ON HEALTH LAW – Sen. Dick Durbin is chairing a Judiciary Committee hearing today on the constitutionality of the health reform law, days after Vinson’s ruling in Florida. Durbin plans to argue that the bill is constitutional and that the legal challenges to reform are driven by partisan opposition to the law, according to his office. Witnesses include: Oregon AG John Kroger; Georgetown’s Randy Barnett; Jones Day’s Michael Carvin; Walter Dellinger of Duke and a former solicitor general; Charles Fried of Harvard and a former solicitor general.

--A GOP aide raises the question: If pro-reform folks continually say we ought not relitigate the health care law and are critical when House committees do so, then why is it OK for Democrats to hold hearings on the law?

QUOTE OF THE DAY – “Girl, you’ve got to have it” – what Sen. Dick Durbin told his then-post-college-aged daughter when she told him she didn’t need to worry about health insurance. He made the comments on the Senate floor Tuesday.

Actavis Mid-Atlantic LLC was ordered to pay $170 million in a Medicaid fraud case, the Austin American-Statesman reports. http://bit.ly/hEaEo6

South Carolina’s Medicaid director told the state’s legislature that without an infusion of $228 million “hundreds of thousands of poor, disabled and elderly” may be cut from the program, the Charleston Post-Courier reports. http://bit.ly/fRAXfY

The New York Times and bloggers read the tea leaves in a Florida judge’s ruling. http://nyti.ms/gS1ZEU
Pfizer eliminates 1,100 jobs in Connecticut as profits soar, the Hartford Courant reports. http://bit.ly/gcA9dK

** A message from BD (Becton, Dickinson and Company): Headquartered in Franklin Lakes, New Jersey, BD was founded in 1897 and has grown into a leading global medical technology company with more than 29,000 associates in 50 countries. The Company applies its technologies and expertise to address fundamental healthcare needs, and its products are found in healthcare settings all over the world. BD’s capabilities help combat significant diseases worldwide by improving drug delivery, enhancing the quality and speed of infection diagnosis, and advancing research, discovery and production of new drugs and vaccines. It serves healthcare institutions, life sciences researchers, clinical laboratories, the pharmaceutical industry and the general public in pursuit of its purpose, “Helping all people live healthy lives.”